Provider Demographics
NPI:1952069189
Name:NELSON, KRYSTLE MARIE
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:MARIE
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5858 POPPY HILLS ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9011
Mailing Address - Country:US
Mailing Address - Phone:509-264-6939
Mailing Address - Fax:
Practice Address - Street 1:1505 WESTLAKE AVE N STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-6211
Practice Address - Country:US
Practice Address - Phone:206-301-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60741716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse